Provider Demographics
NPI:1578905865
Name:LUNG SPECIALIST OF WILLIAMSBURG PC
Entity Type:Organization
Organization Name:LUNG SPECIALIST OF WILLIAMSBURG PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBRAMANIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-707-3999
Mailing Address - Street 1:121 BULIFANTS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5736
Mailing Address - Country:US
Mailing Address - Phone:757-707-3999
Mailing Address - Fax:757-707-3993
Practice Address - Street 1:121 BULIFANTS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5736
Practice Address - Country:US
Practice Address - Phone:757-707-3999
Practice Address - Fax:757-707-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-27
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246032207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty